Team Leader, Customer Service

BlueCross BlueShield of Vermont•Berlin, VT

15h

About The Position

The Team Leader assists the Supervisor in maintaining the efficient day-to-day operations of the Department. The Team Leader is responsible for ensuring that all service requests and claims are accurately handled and processed and the inventory/workload that the team is responsible for is processed in a timely manner. The Team Leader will be expected to provide aged inventory reports of open items that need resolution to the supervisor weekly. The Team Leader responds to the more complex issues or claims received in the unit, and assists staff in developing and applying their own skills and knowledge on an on-going basis. Specific to BlueCard, this involves regular telephone and electronic communication with the other Plans to assure that providers and subscribers are accurately and promptly paid for services rendered or received. The Team Leader participates in the planning of and training for system related projects and at times will be expected to serve as a subject matter expert on corporate projects. The Team Leader assists the supervisor with scheduling staff to expedite workflow, while meeting departmental demands. In addition the Team Leader will be responsible for checking staff productivity information to ensure that it is done accurately and timely. The position will also provide other administrative support to the supervisor when required. This position acts as a back up to the Supervisor in his or her or his absence. Key contacts include team members, providers, members, management and staff of BCBSVT, its subsidiaries and business partnerships, senior management and staff of other BCBS plans.

Requirements

Associate’s degree in business with three years related experience, or equivalent, is required.
BCBS Management Development Program guidelines require all Team Leaders to achieve Professional Development Certification in all modules contained in “Introduction to Team Leader and Mentor” within two years of being selected for the position.

Nice To Haves

One to three years of BCBS internal company experience in Blue Card, FEP, or Operations is desired.

Responsibilities

Assist Supervisor in maintaining the efficient day-to-day operation of the department.
Assist in the evaluation of employee performance on an on-going basis as input for Supervisor’s preparation of employee performance appraisals. Assist the Supervisor in interviewing prospective staff. Encourage team spirit by example and deal proactively with employee issues.
Assist the Supervisor in scheduling staff to meet the demands of workflow. Coordinate the work distribution among staff for special projects.
Handle the more complex calls or claims received in the department.
Monitor production daily and check staff productivity reports to ensure they are current and accurate. In FEP, monitors the queue to achieve a balanced distribution of the workload.
Provide aged inventory reports for aged items which the department is responsible.
Assist in the handling of escalated cases to ensure timely resolution.
Provide training for new employees and cross training for current employees to support a well-trained pro-active staff.
Act as a mentor to staff to help them develop and enhance their skills and knowledge base. Be proactive in identifying additional training needs.
Review procedures on a regular basis to identify, recommend, and develop changes to internal policies or procedures that would lead to more efficient processing.
Assist the QA person in writing procedures specific to the department to incorporate Policy and procedures.
Participate in the planning and execution of semi annual ITS software releases. Train staff and update procedures for new functionality.
Communicate electronically and by telephone as necessary with other Blues Plans in order to properly adjudicate all out of area claims. Handle manually those claims that are incapable of being processed by the system.
Review, investigate and correct suspended claims or open customer inquiries relying on department procedures, system files, and through direct contact with other Plans as necessary.
Determine the correct level of coding and/or reimbursement for claims relying on department procedures, system files, and direct contact with the other Plans as necessary.
Resolve promptly all claims and inquiry omissions and discrepancies by working productively with other departments within the Plan, and by contacting providers, subscribers and Control/Par Plans as necessary.
Participate in departmental planning and execution of action plans
Participate in the preparation of reports on inventories and staffing needs.